Mycoplasmas and erythema multiforme.
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Adolescent↗
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Intradermal test and serological tests in suspected brucella infection in man.
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Agglutination Tests↗
Evidence of a pattern in the variable host response to brucella in man.
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Agglutination Tests↗
Fc receptor blockade in patients with refractory chronic immune thrombocytopenic purpura with anti-D IgG.
BACKGROUND: This is an evaluation of the treatment of 63 patients with chronic immune thrombocytopenic purpura (54 splenectomized and nine nonsplenectomized) with weekly doses of anti-D (IgG)-coated red blood cells (RBCs). METHODS: All patients were given one 5-15 microg/kg/dose of intravenous (i.v.) anti-D (IgG)-coated RBCs per week (average of 300 microg/dose/week) for a median 3-month period (3-6 months). Treatment modality was evaluated on a weekly basis by platelet counts, measuring of hemoglobin levels, and performance of Coombs tests. RESULTS: All patients presented a clinical response. Fifty-two patients (82.5%) increased their platelet count (PC) and 45 (69.8%) increased their PC >50 x 10(9)/L. In 34 cases, response was sustained. Six of nine nonsplenectomized patients (67%) increased PC, thus avoiding splenectomy; four patients attained a stable complete response (CR). Similar platelet responses were observed in homozygous and heterozygous Rh (D)-positive patients (Rh/Hr phenotypes). Currently, after >10 years, 43 patients present a now permanent complete response with platelet count >50 x 10(9)/L. Ten patients subsequently decreased their platelet count, although they were able to attain CR after receiving six doses of anti-D (IgG)-coated RBCs. CONCLUSIONS: Based on our study of Fc receptor blockade treatment with anti-D (IgG)-coated RBCs with the most difficult cases of ITP, which resulted in a 69.8% successful response rate, we concluded that weekly prescription of anti-D (IgG)-coated RBCs is an effective approach to treating chronic refractory ITP.
Adolescent↗
Cutaneous manifestations associated with the presence of the lupus anticoagulant. A report of two cases and a review of the literature.
Two patients with the lupus anticoagulant exhibited unusual cutaneous manifestations. They both fulfilled four criteria for systemic lupus erythematosus and had experienced deep venous thrombosis. The first patient suffered from a leg ulcer that resembled a pyoderma gangrenosum. The second patient presented erythematous and purplish macules on the fingertips. The histologic studies showed only microthrombosis in the dermal vessels without vasculitis, although such lesions in systemic lupus erythematosus are usually attributed to vasculitis. The association of these cutaneous lesions with lupus anticoagulant has never been reported. It is likely that this association is not fortuitous. After a review of the literature, it seems possible to individualize a new syndrome characterized by the presence of a subgroup of antiphospholipid antibodies. Thrombosis, spontaneous abortions, neurologic manifestations, pulmonary hypertension, positive results of a Coombs' test, and thrombocytopenia can be included in this syndrome, which overlaps with systemic lupus erythematosus. Certain cutaneous symptoms are associated with the presence of lupus anticoagulant or other antiphospholipid antibodies: leg ulcers, distal cutaneous ischemia, widespread cutaneous necrosis, and livedo. They can be considered as the dermatologic manifestations of this syndrome.
Adult↗
Congestive heart failure and respiratory arrest secondary to methyldopa-induced hemolytic anemia.
We report a case of methyldopa-induced hemolytic anemia in a 64-year-old woman who presented to the emergency department in congestive heart and respiratory failure. She subsequently suffered a respiratory arrest and required endotracheal intubation and brief CPR. After the initial evaluation revealed anemia and a 3+ positive Coombs' test, a diagnosis of methyldopa-induced hemolytic anemia was entertained. Withdrawal of the drug and supportive therapy resulted in the complete recovery of the patient. Emergency physicians should be aware of this syndrome and be able to diagnose it early in its course, avoiding potential morbidity and mortality. A discussion of the pathophysiology, diagnosis, treatment, and prognosis of the syndrome is given.
Anemia, Hemolytic↗
[Hyperthyroidism and immune hemolytic anemia following amiodarone therapy].
We report the cases of two patients who, after prolonged amiodarone therapy developed hyperthyroidism and immune haemolytic anaemia. Antibodies were of the IgG type and non-specific at elution. A search for other causes of haemolytic anaemia with positive Coombs' test gave negative results. Antiamiodarone antibodies have recently been discovered; they reflect an immunological disturbance due to this drug and might be responsible for some of the undersirable effects of amiodarone. In our patients, hyperthyroidism and haemolytic anaemia were induced by a dual mechanism: accumulation of amiodarone and induction of an effect of this drug on the immune system.
Aged↗
[Myelofibrosis regressing under corticotherapy and intravenous immunoglobulins in an infant].
BACKGROUND: Primary myelofibrosis is rare in infants and children; its association with auto-immune markers has only been reported in adults. CASE REPORT: An 8 month-old girl was admitted because of severe anemia and neutropenia. The marrow aspirate showed dysgranulopoiesis and partial interruption of maturation after the myelocyte level. The bone marrow biopsy revealed reticulinic myelofibrosis. The condition worsened with development of agranulocytosis and thrombocytopenia. Investigations ruled out malignant hemopathy, metastatic infiltration of the marrow and osteopathy. A myelodysplastic syndrome was discussed, but presence of anti-granulocyte auto-antibodies and positive Coombs test led to consider an autoimmune etiology. A corticosteroid therapy was attempted, effective only on the platelet lineage. Addition of intravenous gammaglobulin therapy corrected the problem. After a 24 month-course of the disease, it was necessary to prolong therapy. CONCLUSION: The efficacy of gammaglobulins may be an additional argument for auto-immunity, although no other auto-immune pattern has been observed in our patient, contrary to reported cases in adults.
Combined Modality Therapy↗
The epidemiology of Salmonella dublin infection in a dairy herd. II. Serology.
A number of serological tests were evaluated in a study of Salmonella dublin infection in a dairy herd. None of the tests used detected either of the two carrier animals from which Salmonella dublin was isolated at slaughter 7 and 17 months after the herd infection. The complement fixation tests used proved to be a better guide to the presence of recent herd infection than the conventional ;O' or ;H' agglutination tests.
Agglutination Tests↗
Brucellosis in Northern Ireland. A serological survey.
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Agglutination Tests↗
Differentiation of the serologicl response to Yersinia enterocolitica and Brucella abortus in cattle.
The serological responses of cattle to inoculation with Brucella abortus and Yersinia enterocolitica type IX were compared. Complete cross-reactions were found in serum agglutination, antiglobulin, complement fixation and Rose Bengal plate tests. The cross-reaction between Br. abortus and Y. enterocolitica IX was confirmed by immunodiffusion tests. Although antibodies specific for each organism could also be detected by immunodiffusion tests with high titre rabbit or bovine sera, these tests were insufficiently sensitive for routine diagnostic use.A quantitative Rose Bengal plate test, using Rose Bengal stained Br. abortus and Y. enterocolitica IX, was developed which enabled the antibody responses to the two organisms to be differentiated. The specificity of this test was confirmed by cross-absorption experiments and its sensitivity was sufficient to permit evaluation of all bovine sera giving positive reactions to the serum agglutination test.
Agglutination Tests↗
Serum antibody response in acute brucellosis.
The serum antibody titres in 62 cases of acute brucellosis are presented. The antibody persisiting after infection and the appearance of non-agglutinating anti-human globulin titres were investigated. The criteria for the serological diagnosis of acute and chronic brucellosis are discussed.
Acute Disease↗
The serological relationship between Brucella spp., Yersinia enterocolitica serotype IX and Salmonella serotypes of Kauffmann-White group N.
The serological relationship between Brucella spp., Yersinia enterocolitica IX, and the group N salmonella serotypes S. godesberg, S. landau, S. morehead, S. neusdorf, S. soerenga and S. urbana was examined using agglutination, antiglobulin, complement fixation, immunodiffusion and fluorescent antibody methods. Antisera to the group N salmonella serotypes all reacted to significant titres in agglutination and complement fixation, but not antiglobulin or immunodiffusion tests with smooth brucella antigens. These antisera also reacted in agglutination, but not antiglobulin, tests with Y. enterocolitica IX. They did not react significantly in any tests with rough brucella antigens. Conversely, antisera to smooth Brucella spp. agglutinated group N salmonellas to low titre and Y. enterocolitica IX to titres similar to those given against the homologous strain. Antiserum to Y. enterocolitica IX on the other hand reacted with smooth brucella antigens to high titre in agglutination, complement fixation and antiglobulin tests, and with the group N salmonella antigens to substantial titres in agglutination tests. In direct fluorescent antibody tests, smooth Brucella strains and Y. enterocolitica IX reacted strongly with FITC-labelled antibody to Br. abortus whereas the group N salmonella strains reacted weakly. In tests with monospecific antisera to the A and M determinants of Br. abortus and Br. melitensis respectively, Y. enterocolitica IX reacted only with the antiserum to the A determinant whereas group N salmonellas reacted to low titre with both A and M antisera. The results of cross-absorption tests confirmed this relationship and suggested that the O30 antigens of group N salmonella serotypes contained antigenic determinants similar to, but not identical with, the antigenic structure shared by smooth Brucella spp. and Y. enterocolitica IX.
Absorption↗
[Use of human intravenous immunoglobulin in dogs with primary immune mediated hemolytic anemia].
Immune mediated hemolytic anemia (IMHA) in dogs is a severe disease with a high mortality rate. As human immunoglobulin (HIG) was reported to be beneficial for the treatment of IMHA in dogs we examined the influence of HIG on the course of the disease in our dogs with IMHA. Of 22 dogs with primary IMHA 9 dogs received in addition to routine immunosuppressive therapy HIG at a dose of 0.19 to 0.68 g/kg (median 0.35 g/kg), 13 dogs did not receive HIG (-HIG group). Both groups were similar in terms of age, weight, the presence of autoagglutination, spherocytosis, positive Coombs' test, icterus and pigmenturia. The lowest hematocrit measured during the disease was significantly lower in the +HIG group compared to the -HIG group and dogs in the +HIG group received significantly more transfusions than those of the -HIG group. This is an indication for more severe disease signs of the +HIG group dogs. Although mortality during hospitalization and the time from hospital admission to release or death was not significantly different between the two groups, we interpret this similar course of the IMHA despite more severe signs of the +HIG group dogs as a potential positive effect of the HIG therapy.
Anemia, Hemolytic, Autoimmune↗
Incomplete antibodies in rhinoscleroma.
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Agglutination Tests↗
De novo chronic graft-versus-host disease presenting as hemolytic anemia following partially mismatched related donor bone marrow transplant .
Chronic graft-versus-host disease (cGVHD) is a disease of immune dysregulation that resembles an autoimmune disease. It usually involves the skin, mucosal and serosal surfaces and, less commonly, the hematopoietic system. We report hemolytic anemia (HA) as the primary manifestation of de novo cGVHD in recipients of partially mismatched related donor transplants. Five of 40 eligible patients developed HA at a median of 168 days post-transplant. Recipients were mismatched for one to three major HLA antigens. Conditioning therapy consisted of total body irradiation, etoposide, Ara-C, cycle-phosphamide and steroids. GVHD prophylaxis included partial T cell depletion, using anti alpha/beta CD3 antibody (T10B9) and complement, in addition to post-transplant immunosuppression. At presentation, all patients were receiving cyclosporine with or without low-dose steroids. Along with a mean Hb of 7.1 g%, patients had an increased reticulocyte count, a mild raised lactic dehydrogenase and a positive Coombs' test (in 2/5 patients). Four patients had also demonstrated a decrease in platelet count. Treatment was initiated with high-dose steroids and intravenous gamma globulin and response was observed within 1 week. Awareness of this presentation of cGVHD and early therapeutic intervention can result in successful reversal of presumed immune-mediated red cell and platelet destruction.
Adrenal Cortex Hormones↗
Design of the prospective randomized study for the treatment of patients with thrombotic microangiopathy. PRODROMI Study Group.
In thrombotic microangiopathies hemolytic uremic syndrome and thrombocytopenic purpura, plasma exchange (PE) therapy using fresh frozen plasma is standard. In almost 20% of the patients, however, this approach is ineffective. This prospective, randomized study for the treatment of patients with thrombotic microangiopathies (PRODROMI) compares PE with fresh frozen plasma (A) and cryosupernatant (B). The participating centers were the University Clinics of Freiburg, Hamburg, Düsseldorf, Essen, Göttingen, Mannheim, Ulm, Jena, Tübingen, Würzburg, Kreiskrankenhaus Offenburg, Städt Klinikum Karlsruhe, and Horst-Schmidt Kliniken in Wiesbaden, Germany. Patients (18 to 80 years) were diagnosed by the individual centers based on clinical and laboratory findings (thrombocyte/fragmentocyte count, hemoglobin, serum creatinine, haptoglobin and lactate dehydrogenase levels; negative Coombs-test is obligatory). HIV infection, bone marrow, or solid organ transplantation were exclusion criteria. After written consent, patients were randomized in the A or B group. All patients received 1.5 mg/kg methylprednisolone as a basic therapy. The first PE always was performed with fresh frozen plasma (50 ml/kg). A minimum of 5 and a maximum of 10 PEs were required. Thrombocyte count above 150,000/microl was considered to be a successful therapy. Treatment failure was defined as not responding to 10 PE with a thrombocyte count above 150,000/microl or a fall below this value within 30 days after stopping PE. Patients with clinical and laboratory signs of thrombotic microangiopathy occurring later than 30 days after having stopped PE were considered to have a relapse. Primary endpoints were survival, intensity of required PE sessions (duration, volume, and number), and relapse rate. Follow-up of clinical outcome was 2 years; von Willebrand Factor (vWF), vWF-cleaving-protease activity, and Factor H were determined.
Adolescent↗